The outbreak "really is a crisis and is affecting most if not all the counties in Liberia already," he told NPR from Monrovia, the capital city and first stop on a three-country visit. "This is absolutely unprecedented."

The CDC, Frieden said, "is working flat out on this, but this is huge and needs a global response. ... They need a lot of help from the world."

He emphasized that the toll is "far larger than has been recorded, not because they are trying to hide anything but because they are really overwhelmed by these numbers." Beyond this, he said, the cases "are increasing at an extremely quick rate, and this is very alarming."

As bad as the Ebola situation is, Frieden warned that the worst is yet to come. "Unfortunately, we are definitely not at the peak. It's going to get worse before it gets better," he said. "The real question is how much worse will it get? How many more people will be infected and how much more risk to the world will there be?"

Because of the outbreak, Liberians who require other kinds of medical care have avoided seeking help. "Urgent health needs are definitely going unmet," Frieden said. "Hospital occupancy" is 10 percent. This means one of the urgent tasks ahead is to make sure treatment is available to patients who are not suffering from Ebola.

Ending the crisis hinges largely on improving infection control and burial practices, Frieden said. Until now, "cremation was not part of the burial culture here," he said, but people are increasingly accepting it.

Liberia suffered immensely even before Ebola struck, with a prolonged civil war that killed 250,000 people. "Liberia has been through so much in the last 15 or 20 years," Frieden said. "This is really almost re-traumatizing people here."

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Transcript

MELISSA BLOCK, HOST:

This is ALL THINGS CONSIDERED from NPR News. I'm Melissa Block.

ROBERT SIEGEL, HOST:

And I'm Robert Siegel. The Ebola outbreak in West Africa has killed more than half of the more than 2,600 people thought to have been infected. But a senior U.S. health official who's touring the region says from what he can see the actual number of infections and deaths is far higher. Doctor Tom Frieden is the director of the U.S. Centers For Disease Control and Prevention he spoke to us today from Monrovia, the capital of Liberia, where he's getting a firsthand look at the epidemic.

TOM FRIEDEN: There are more cases here than have been reported. There are more cases than have been diagnosed and there are patients that are just far, far, far, too many for the treatment services. And what that means is that Ebola is spreading widely in communities. This is absolutely unprecedented.

SIEGEL: How is it evident that there are more Ebola cases than have been reported?

FRIEDEN: We're tracking how the reporting is done. We're tracking how the laboratory testing is done. We're tracking how the health ministry is dealing with their data and realizing that the numbers are far larger than have been reported, not because they're trying to hide anything, but because they're really overwhelmed by these numbers. No one expected this.

SIEGEL: I know that you visited the JFK Hospital in Monrovia today, one thing that we've heard is that people who should be going to the hospital for other reasons, women in labor for example, are staying away because they - they're fearful. They're afraid that if they go to the hospital they'll contract Ebola. First of all, is that a justified fear?

FRIEDEN: Well, first off the fact is what you've heard is correct. The occupancy of the hospital is only about 10 percent. So, there are definitely urgent health needs going unmet whether that's malaria or pneumonia or conditions that can be fatal. So, the fears have at times been justified because there has been spread among patients in healthcare facilities. So, one of our urgent tasks is not just to get the Ebola treatment up but also to get the treatment restarted throughout the country for patients without Ebola.

SIEGEL: Our team there has reported on the quarantine on the neighborhood in Monrovia - West Point, I gather there's also a quarantine in a rural County on the Liberian border with Sierra Leone and Guinea. Did you learn anything in meetings today about the situation there and is that quarantine still in effect?

FRIEDEN: The situation in Foya, which is the rural area that's part of what's really a three country common border area which has been the epicenter and probably the place where this started, has been very intense. That remains an area where there's a lot of transmission, the needs are enormous. And the two main things that are going to turn this around are improving healthcare infection control and improving burial practices. And healthcare infection control can only be improved when there are enough beds for patients with Ebola. And right now there are far, far too few.

SIEGEL: And you said burial practices. I gather that the safest burial practice is cremation and there's been some progress on that front?

FRIEDEN: Yes, you know, cremation was not part of the burial culture here but remarkably and I think not unexpectedly in just a week after seeing too many dead bodies to be carefully buried, the community and families have increasingly accepted cremation as an acceptable form of burial. But the challenges are enormous. The government and even the non-government organizations are not able to keep up with requests for removal of dead bodies from the community. It's a horrific situation.

SIEGEL: Is it evident to you when you go to Monrovia, that this is a city that's suffering from an Ebola outbreak or do you have to go look for it and be on an official trip to see that?

FRIEDEN: Some of the signs of change are everywhere you go. People have - you people wash your hands with a bleach solution before you go, but probe a little deeper and you'll recognize that the economy is having severe problems. That shipments, flights have been canceled, tourism is down, business is down. People are afraid and that there's hardly any were here who doesn't know someone, who doesn't have a family member who's been touched by a death by Ebola and these deaths are so horrific and Liberia has been so much over the past 15 or 20 years. That really it's really almost re-traumatizing to the people here.

SIEGEL: Doctor Frieden thank you very much for talking with us today.

FRIEDEN: Thank you.

SIEGEL: That's Doctor Tom Frieden, who's the director of the U.S. Centers for Disease Control and Prevention. He is in Monrovia, the Liberian capital, at the start of a three country tour looking into the Ebola outbreak. Transcript provided by NPR, Copyright NPR.